Research Project

Gender bias permeates many aspects of medicine in India, the WHO acknowledged the need for integration of gender into medical curricula. CEHAT, in collaboration with DMER and MUHS to facilitate gender perspectives in medical education in Maharashtra . An important contribution of the project has been the development of gender integrated modules across five disciplines namely Community Medicine, Gynecology and Obstetrics, Forensic Science and toxicology, Medicine and Psychiatry for MBBS course These gender integrated modules were tested through a quasi experimental research design to assess the feasibility of teaching gender integrated medical curriculum and also assess whether teaching such a curriculum can lead to positive attitude amongst the students towards gender. The report “TITLE” presents the experience of facilitating gender perspectives for medical students as well as positive changes in their attitudes. An important learning was the need to integrate gender across relevant medical topics throughout MBBS course. This reiterated the fact that gender as a social determinant cannot be relegated to only lectures/elective course; rather they need to be mainstreamed in to the medical curricula to enhance the understanding about the same.

Social determinants, including gender, affect health and access to healthcare and the practice of medicine, medical research and programme planning has not taken cognisance of these. The World Health Organization (WHO) recognized the importance of integration of gender in medical education in 2007. Having worked on gender based violence; CEHAT too recognised its importance. We collaborated with the Department of Medical Education (DMER) and Maharashtra University of Health Sciences (MUHS) in order to enable integration of gender perspectives in medical education. The collaboration was a rigorous and fulfilling process for all those involved. The DMER deputed middle to senior medical faculty from seven medical colleges across five disciplines that were shortlisted for integrating gender concerns - Community medicine; Gyanecology and obstetrics; Forensic science and toxicology; Medicine and Psychiatry. Accordingly, twenty such medical educators from underwent gender sensitive training that eventually enabled them to identify gender gaps in medical education, research and practice. These medical educators along with mentors and CEHAT team identified gender related gaps in medical curriculum and designed modules that would facilitate gender perspectives in the five disciplines. Besides the gender integrated content, it was important that the evidence based gender content be integrated into existing lectures. The modules use interactive methodology such as role plays, case studies and other interactive tools. The modules were tested through a quasi-experimental research design to assess whether gender integrated teaching can facilitate changes in gender perspectives of students. The findings were positive and the results of the study showed that there was indeed a strong association between not just the exposure to such curriculum, but also the number of lectures attended. The modules have subsequently undergone further rigorous and collaborative development and are presented here. We hope that these would be not just used for MBBS students, but also by all those keen on understanding more about the importance of gender in health, health care, medical research and planning programmes at the grassroots as well as policy level.

This project is aimed at the training of medical educators in state medical colleges in Maharashtra to incorporate a gender perspective in their teaching with a focus on issues of gender-based violence and discrimination. The need for this project stems from the key role that medical teachers can play in recognizing and addressing gender bias in medical education and practice, which often translates into poorer outcomes in health service delivery for women. Further, health care providers constitute the first point of contact for survivors of domestic and sexual violence. They can play a critical role not only in evidence collection and treatment, but also in identifying women who may be facing violence but may not report it. There is need for sensitization of the medical profession in understanding violence against women as a health issue and adequate training in addressing it.

In order that medicine becomes more gender sensitive, educating medical practitioners on gender issues and how gender interacts with other determinants of health is important. This is a crucial first step to change biases that exist in the field of medicine at different levels including research, service delivery, textbooks and teaching. This project aims to integrate gender perspectives in medical teaching and curriculum in Maharashtra by training faculty members of five disciplines, namely, Obstetrics/Gynaecology, Internal Medicine, Psychiatry, Preventive and Social Medicine and Forensic Medicine. The focus is on issues related to violence against women and sensitization of medical students and professionals.

The specific objectives of this project over three years are:

Build capacity of medical teachers on gender and violence through a training of trainers’ [TOT] programme: Participating colleges will send in five faculty members each, one from each of the above disciplines, to be trained in a 10 days course to be conducted over two phases.

Facilitate teaching of gender perspectives in medical curricula by trained medical educators: The 30 participating faculty members so trained will be instrumental in introducing gender perspectives in their classroom teaching. They will also prepare teaching material for the same. Mentoring support will be provided by course faculty members to each participant in the process.

Advocate for policy inclusion of modules integrating gender perspectives in medical curriculum by assessing impact: Participants will undergo impact assessment and evaluation before and after training. A working group comprising of deans of participating colleges, representatives from DMER and MUHS, project faculty members as well as participating faculty members will be formed in order to advocate for integration of the project output in the medical curriculum in the state.

The above mentioned objectives have been successfully achieved over a period of 3 years. At present there is a pool of 19 GME trained educators across 7 medical colleges of Maharashtra. In order to test the efficacy of the GME modules an intervention study was carried out in 3 out of 7 medical colleges for two disciplines in one of the semesters. The results of before and after evaluation after the implementation of gender integrated modules have demonstrated that inclusion of gender content in the medical curriculum can bring about a positive change in the gender attitude of medical students emphasising the inclusion of gender in medical curriculum to make gender sensitive doctors in future.

The gender integrated modules have been drafted for 5 years of MBBS curriculum across all 5 disciplines (Obstetrics and Gynaecology, Community Medicine, Internal Medicine, Forensic Medicine and Toxicology and Psychiatry). The drafting of modules has been a team work of all the educators, mentors and the CEHAT team. The modules have gone through a series of reviews from internal experts as well as external experts who are social scientists as well as practicing doctors. The modules have been submitted to DMER and are in the process of being integrated in the undergraduate medical curriculum.

CEHAT is now in the process of taking the work forward by working with these medical colleges to develop protocols to respond sensitively to violence against women and children and thus making the clinical practice gender sensitive.

The report is based on a study conducted among medical educators in seven medical colleges in Maharashtra regarding their perceptions on the relevance of gender in medical education. The study was undertaken as a part of CEHAT’s pioneering work on the integration of gender in medical education in Maharashtra supported by DMER, MUHS and UNFPA. The study explores the perceptions of medical educators regarding social determinants of health in the medical curriculum and gender sensitivity in medical teaching and practice vis-à-vis abortion, sex selection and violence against women. The findings throw light on the dire need to infuse the medical curriculum and training with gender theory and concepts so as to ensure the creation of a gender-sensitive and socially relevant medical force in the country